印度的孕产妇死亡率：基于全国代表性调查的原因及医疗服务利用情况
Maternal mortality in India: causes and healthcare service use based on a nationally representative survey.
作者信息
Montgomery Ann L, Ram Usha, Kumar Rajesh, Jha Prabhat
机构信息
Centre for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael Hospital, Toronto, Ontario, Canada.
Centre for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael Hospital, Toronto, Ontario, Canada ; International Institute for Population Sciences, Mumbai, India.
出版信息
PLoS One. 2014 Jan 15;9(1):e83331. doi: 10.1371/journal.pone.0083331. eCollection 2014.
BACKGROUND
Data on cause-specific mortality, skilled birth attendance, and emergency obstetric care access are essential to plan maternity services. We present the distribution of India's 2001-2003 maternal mortality by cause and uptake of emergency obstetric care, in poorer and richer states.
METHODS AND FINDINGS
The Registrar General of India surveyed all deaths occurring in 2001-2003 in 1.1 million nationally representative homes. Field staff interviewed household members about events that preceded the death. Two physicians independently assigned a cause of death. Narratives for all maternal deaths were coded for variables on healthcare uptake. Distribution of number of maternal deaths, cause-specific mortality and uptake of healthcare indicators were compared for poorer and richer states. There were 10,041 all-cause deaths in women age 15-49 years, of which 1096 (11.1%) were maternal deaths. Based on 2004-2006 SRS national MMR estimates of 254 deaths per 100,000 live births, we estimated rural areas of poorer states had the highest MMR (397, 95%CI 385-410) compared to the lowest MMR in urban areas of richer states (115, 95%CI 85-146). We estimated 69,400 maternal deaths in India in 2005. Three-quarters of maternal deaths were clustered in rural areas of poorer states, although these regions have only half the estimated live births in India. Most maternal deaths were attributed to direct obstetric causes (82%). There was no difference in the major causes of maternal deaths between poorer and richer states. Two-thirds of women died seeking some form of healthcare, most seeking care in a critical medical condition. Rural areas of poorer states had proportionately lower access and utilization to healthcare services than the urban areas; however this rural-urban difference was not seen in richer states.
CONCLUSIONS
Maternal mortality and poor access to healthcare is disproportionately higher in rural populations of the poorer states of India.
背景
特定病因死亡率、熟练助产服务及紧急产科护理可及性的数据对于规划孕产妇服务至关重要。我们呈现了印度2001 - 2003年贫困和富裕邦按病因划分的孕产妇死亡率及紧急产科护理的使用情况分布。
方法与结果
印度注册总署对2001 - 2003年在全国具有代表性的110万户家庭中发生的所有死亡情况进行了调查。实地工作人员就死亡前发生的事件采访了家庭成员。两名医生独立确定死因。对所有孕产妇死亡的叙述进行编码，以获取关于医疗保健使用情况的变量。比较了贫困和富裕邦孕产妇死亡人数、特定病因死亡率及医疗保健指标使用情况的分布。15 - 49岁女性的全因死亡人数为10041人，其中1096人（11.1%）为孕产妇死亡。根据2004 - 2006年全印抽样调查（SRS）全国孕产妇死亡率每10万活产254例死亡的估计，我们估计贫困邦农村地区的孕产妇死亡率最高（397，95%置信区间385 - 410），而富裕邦城市地区的孕产妇死亡率最低（115，95%置信区间85 - 146）。我们估计2005年印度有69400例孕产妇死亡。四分之三的孕产妇死亡集中在贫困邦农村地区，尽管这些地区的活产估计数仅占印度的一半。大多数孕产妇死亡归因于直接产科原因（82%）。贫困和富裕邦之间孕产妇死亡的主要原因没有差异。三分之二的女性在寻求某种形式的医疗保健时死亡，大多数是在病情危急时寻求治疗。贫困邦农村地区获得和利用医疗保健服务的比例低于城市地区；然而，在富裕邦没有看到这种城乡差异。
结论
印度贫困邦农村人口的孕产妇死亡率和医疗保健可及性差的情况尤为严重。
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